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Big Question 2: What progress has been made on Global THR?

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[9] Euromonitor International, Market Sizes, Heated Tobacco – Japan, Tobacco: Euromonitor from trade sources/national statistics. (Accessed: 5 Feb 2026)

Big Question 3: Why is THR important to BAT?

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Big Question 4: What is BAT doing to address underage access to tobacco and nicotine products?

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[2] UK Legislation, Children Act, Part III. Juvenile Smoking, 1908, Part III.

[3] BAT, Responsible Marketing Principles.

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Big Question 5: What is the risk of using Smokeless Products compared to smoking?

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[2] Doll, R., et al., Mortality in relation to smoking: 50 years’ observations on male British doctors. Br Med J, 2004. 328(7455): p. 1519. DOI:10.1136/bmj.38142.554479.AE

[3] Nutt, D.J., et al., Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res, 2014. 20(5), p. 218-225. DOI:10.1159/000360220

[4] U.S. Food & Drug Administration (FDA). CTP Director Discusses Opportunities and Considerations for Addressing Misperceptions About the Relative Risks of Tobacco Products Among Adults Who Smoke. 2023. (Accessed: 24 June 2026)

[5] World Health Organization (WHO), The Scientific Basis of Tobacco Product Regulation. WHO Press, 2008.

[6] Forster, M., et al., Assessment of novel tobacco heating product THP1.0. Part 3: Comprehensive chemical characterisation of harmful and potentially harmful aerosol emissions. Regul Toxicol Pharmacol, 2018. 93: p. 14-33. DOI:10.1016/j.yrtph.2017.10.006

[7] Pinto, M.I., et al., Chemical characterisation of the vapour emitted by an e-cigarette using a ceramic wick-based technology. Sci Rep, 2022.12(1):16497. DOI:10.1038/s41598-022-19761-w

[8] Azzopardi, D., et al., Chemical characterization of tobacco-free “modern” oral nicotine pouches and their position on the toxicant and risk continuums. Drug Chem Toxicol, 2022. 45(5): p. 2246-2254. DOI:10.1080/01480545.2021.1925691

[9] Gale, N., et al., Changes in biomarkers of exposure and biomarkers of potential harm after 360 days in smokers who either continue to smoke, switch to a tobacco heating product or quit smoking. Intern Emerg Med 17, 2017–2030 (2022). DOI:10.1007/s11739-022-03062-1

[10] Committee on Toxicity, Toxicological evaluation of novel heat-not-burn tobacco products – non-technical summary. 2017.

[11] Public Health England, Evidence review of e-cigarettes and heated tobacco products 2018: executive summary. 2018. (Accessed: 20 June 2026)

[12] U.S. Food & Drug Administration, FDA permits sale of IQOS Tobacco Heating System through premarket tobacco product application pathway. 2019. (Accessed: 18 June 2026)

[13] German Federal Institute for Risk Assessment (BFR), Frequently asked questions about e-cigarettes. 2020. (Accessed: 16 June 2026)

[14] Federal Public Service Health and Food Chain Safety and Environment, New Tobacco Products: Heated Tobacco Products. Belgium Superior Health Council, 2020.

[15] Slob, W., et al., A Method for Comparing the Impact on Carcinogenicity of Tobacco Products: A Case Study on Heated Tobacco Versus Cigarettes. Risk Anal, 2020. 40(7): p. 1355-1366. DOI:10.1111/risa.13482

[16] Evaluation of risks related to vaping products: Opinion by ANSES: collective expertise report. (Accessed: 16 June 2026)

[17] Gale, N., et al., Changes in biomarkers of exposure and biomarkers of potential harm after 360 days in smokers who either continue to smoke, switch to a tobacco heating product or quit smoking. Intern Emerg Med 17, 2017–2030 (2022). DOI: 10.1007/s11739-022-03062-1

[18] Haswell, L.E., et al., Biomarkers of exposure and potential harm in exclusive users of electronic cigarettes and current, former, and never smokers. Intern Emerg Med, 2023. 18: p. 1359-1371. DOI:10.1007/s11739-023-03294-9

[19] Azzopardi, D., et al., Assessment of biomarkers of exposure and potential harm, and physiological and subjective health measures in exclusive users of nicotine pouches and current, former and never smokers. Biomark, 2023. 28(1): p. 118-129. DOI:10.1080/1354750X.2022.2148747

[20] Kanobe, M.N., et al., Changes in Biomarkers of Exposure and Potential Harm in Smokers Switched to Vuse Vibe or Vuse Ciro Electronic Nicotine Delivery Systems. Toxics, 2023. 11(7), p. 564. DOI:10.3390/toxics11070564

[21] Niessner, R., The potential of smoke-free products to reduce harm for smokers: what does the toxicological evidence say? Intern Emerg Med, 2025. 1989-1994. DOI: 10.1007/s11739-025-04093-0

[22] Royal College of Physicians (RCP), Nicotine without smoke: tobacco harm reduction. RCP, 2016.

[23] Chen, J., et al., A comparative health risk assessment of electronic cigarettes and conventional cigarettes. Int J Environ Res Public Health, 2017. 14(4): 382. DOI:10.3390/ijerph14040382

[24] McNeill, A., et al., E-cigarettes: an evidence update. Public Health England, 2015. (Accessed: 16 June 2026)

[25] Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT), Statement on the potential toxicological risks from electronic nicotine (and non-nicotine) delivery systems (E(N)NDS – e-cigarettes). 2020. (Accessed in September 2023, when Omni was first launched)

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[27] Benowitz, N.L., et al., Clinical Pharmacology of Electronic Nicotine Delivery Systems (ENDS): Implications for Benefits and Risks in the Promotion of the Combusted Tobacco Endgame. J Clin Pharmacol, 2021. 61: p. S18-S36. DOI:10.1002/jcph.1915

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Big Question 6: What is nicotine?

[1] U.K. National Health Service (NHS), Vaping myths and facts. (Accessed: 20 May 2026)

[2] Moldoveanu, S.C., et al., Nicotine analysis in several non-tobacco plant materials. Contrib Tob Nicotine Res, 2016. 27(2): p. 54-59. DOI:10.1515/cttr-2016-0008

[3] Villanti, A.C., et al., Latent classes of nicotine beliefs correlate with perceived susceptibility and severity of nicotine and tobacco products in US young adults. Nicotine Tob Res, 2019. 21(Supplement_1): p. S91-S100. DOI:10.1093/ntr/ntz156

[4] U.S. National Cancer Institute, How much do you agree or disagree that the nicotine in cigarettes is the substance that causes most of the cancer caused by smoking? Health Information National Trends Survey. (Accessed: 10 May 2026)

[5] Steinberg, M.B., et al., Nicotine risk misperception among US physicians. J Gen Intern Med, 2021. 36(12): p. 3888-3890. DOI:10.1007/s11606-020-06172-8

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[7] Valentine, G., and Sofuoglu, M., Cognitive effects of nicotine: recent progress. Curr Neuropharmacol, 2018. 16(4): p .403-414. DOI:10.2174/1570159X15666171103152136

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[9] IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, Tobacco smoke and involuntary smoking (No. 83). World Health Organization and International Agency for Research on Cancer, 2004.

[10] Jenkins, R.A., et al., Mainstream and sidestream smoke. In The chemistry of environmental tobacco smoke: composition and measurement (2nd ed.), CRC Press, 2000. p 49-75. DOI:10.1201/9781482278651

[11] Rodgman, A., and Perfetti, T.A., The chemical components of tobacco and tobacco smoke. CRC press, 2013. DOI:10.1201/b13973

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[13] Kim, M. M., et al., A systematic review of RCTs to examine the risk of adverse cardiovascular events with nicotine use. Front Cardiovasc Med, 2023. 10, DOI:10.3389/fcvm.2023.1111673

[14] Royal College of Physicians (RCP), Nicotine without smoke: tobacco harm reduction. RCP, 2016.

[15] Office of Health Improvement and Disparities, Smoking and tobacco: applying All Our Health. Gov. UK, 2022 (Accessed: 15 July 2026) (Accessed: 15 July 2026)

[16] BAT, Responsible Marketing Principles.

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[18] Zhang, H., et al., Enantiomeric composition of nicotine in tobacco leaf, cigarette, smokeless tobacco, and e-liquid by normal phase high-performance liquid chromatography. Chirality, 2018. 30:923–931. DOI: 10.1002/chir.22866

[19] Dull, G.M., et al., Chiral analysis of commercial nicotine, synthetic nicotine, and e-liquids. R.J. Reynolds Technical Report, 2022.

[20] Benowitz, N.L., et al., Nicotine chemistry, metabolism, kinetics and biomarkers. Nicotine psychopharmacol (Springer), 2009. p. 29-60. DOI: 10.1007/978-3-540-69248-5_2

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Big Question 7: Are Smokeless Products a gateway to cigarette smoking?

[1] Shahab, L., et al., Unpacking the gateway hypothesis of e-cigarette use: the need for triangulation of individual-and population-level data. Nicotine and Tobacco Research, 2022. 24(8): p. 1315-1318. DOI:10.1093/ntr/ntac035

[2] Khouja, J.N., et al., Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis. Tob Control, 2021. 30(1): p. 8-15. DOI:10.1136/tobaccocontrol-2019-055433

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[5] Vlaams Instituut Gezond Leven, Alle jongeren aan de e-sigaret? Tijd voor een diepgaande analyse van het vapegedrag van Vlaamse jongeren. 2023.

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[43] Lindson, N., et al., Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev, 2024. 1: CD010216. DOI: 10.1002/14651858.CD010216.pub8

[44] Foxon, F., et al., Increased e-cigarette use prevalence is associated with decreased smoking prevalence among US adults. Harm Reduct J, 2024. DOI: 10.1186/s12954-024-01056-0

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Chapter 4: Our Smokeless Science

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[3] Lowe, F., et al., A framework for the assessment of reduced risk tobacco and nicotine products. Recent Advances In Tobacco Science, 2015. 41: p. 51-82.

[4] Murphy, J.,et al., Assessing modified risk tobacco and nicotine products: description of the scientific framework and assessment of a closed modular electronic cigarette. Regul Toxicol Pharmacol, 2017. 90: p. 342-357. DOI:10.1016/j.yrtph.2017.09.008

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[15] Raies, A.B., and Bajic, V.B., In silico toxicology: computational methods for the prediction of chemical toxicity. WIREs Computational Molecular Science, 2016. 6(2), p.147-172. DOI:10.1002/wcms.1240

[16] Caruso, M., et al., Screening of different cytotoxicity methods for the assessment of ENDS toxicity relative to tobacco cigarettes. Regul Toxicol Pharmacol, 2021. 125, p. 105018. DOI:10.1016/j.yrtph.2021.105018

[17] Miller-Holt, J., et al., In vitro evaluation of mutagenic, cytotoxic, genotoxic and oral irritation potential of nicotine pouch products. Toxicol Rep, 2022. 9, p. 1316-1324. DOI: 10.1016/j.toxrep.2022.06.008

[18] Thorne, D., et al., The genotoxicological assessment of a tobacco heating product relative to cigarette smoke using the in vitro micronucleus assay. Toxicol, 2020. 7: p. 1010-1019. DOI:10.1016/j.toxrep.2020.08.013

[19] Clippinger, A.J., et al., Alternative approaches for acute inhalation toxicity testing to address global regulatory and non-regulatory data requirements: An international workshop report. Toxicol In Vitro, 2018. 48: p. 53-70. DOI:10.1016/j.tiv.2017.12.011

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[21] Goniewicz, M.L., et al., Comparison of nicotine and toxicant exposure in users of electronic cigarettes and combustible cigarettes.JAMA Netw Open,2018. 1(8): p. e185937-e185937. DOI:10.1001/jamanetworkopen.2018.5937

[22] Gale, N., et al., Changes in biomarkers after 180 days of tobacco heating product use: a randomised trial. Intern Emerg Med, 2021. 16(8): p. 2201-2212. DOI:10.1007/s11739-021-02798-6

[23] Fearon, I.M., et al., Nicotine pharmacokinetics of electronic cigarettes: a review of the literature. Regul Toxicol and Pharmacol, 2018. 100: p.25-34. DOI:10.1016/j.yrtph.2018.09.004

[24] Liu, J., et al., Nicotine pharmacokinetics and subjective responses after using nicotine pouches with different nicotine levels compared to combustible cigarettes and moist smokeless tobacco in adult tobacco users. Psychopharmacol, 2022. 239(9): p. 2863-2873. DOI:10.1007/s00213-022-06172-y

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[30] Azzopardi, D., et al., Chemical characterization of tobacco-free “modern” oral nicotine pouches and their position on the toxicant and risk continuums. Drug chem toxicol., 2022. 45(5): p. 2246-2254. DOI:10.1080/01480545.2021.1925691

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[37] Haswell, L.E., et al., Biomarkers of exposure and potential harm in exclusive users of electronic cigarettes and current, former, and never smokers. Intern Emerg Med, 2023. 18(5): p. 1359-1371. DOI: 10.1007/s11739-023-03294-9

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[178] Liu, J., et al., Oral Health Effects Among Adults Switching from Cigarettes to on!® Nicotine Pouches Compared to Those Who Continue Smoking. Oral Health Prev Dent, 2025. 23:189-201. DOI: 10.3290/j.ohpd.c_1925

[179] Lee, P.N., et al., Estimating the public health impact had tobacco-free nicotine pouches been introduced into the US in 2000. BMC public health, 2022. DOI: 10.1186/s12889-022-13441-0

Chapter 5: Our Smokeless Products

[1] BAT, Responsible Marketing Principles.

[2] BAT, Responsible Marketing Code.

[3] Paek, H.J., and Hove, T., Risk perceptions and risk characteristics. In Oxford research encyclopedia of communication, 2017. DOI:10.1093/acrefore/9780190228613.013.283

[4] Action on Smoking and Health (ASH), Use of e-cigarettes (vapes) among adults in Great Britain. 2025.

[5] Toll, B.A., et al., Nicotine e-cigarettes: considerations for healthcare providers. Nat Med, 2024. 30: p. 1513–1514. DOI:10.1038/s41591-024-02926-7

[6] Denlinger-Apte, R.L., et al., Risk perceptions of low nicotine cigarettes and alternative nicotine products across priority smoking populations. Int J Environ Res Public Health, 2021. 18(10): p. 5311. DOI:10.3390/ijerph18105311

[7] Goulette, M.R., et al., Perceptions of harmfulness of heated tobacco and nicotine vaping products compared to cigarettes, and the association of advertising exposure on harm perceptions among adults who smoke in South Korea: Cross-sectional findings from the 2020 ITC Korea Survey. Tob Induc Dis, 2023. 21:121. DOI:10.18332/tid/170252

[8] Wackowski, O.A., et al., Smokers' sources of e-cigarette awareness and risk information. Prev Med Rep, 2015. 2: p. 906-910. DOI:10.1016/j.pmedr.2015.10.006

[9] Tobacco Use and Dependence Guideline Panel, Treating Tobacco Use and Dependence: 2008 Update. US Department of Health and Human Service: Atlanta, GA, USA, 2008. (Accessed: 01 May 2026)

[10] Delnevo, C.D., et al., Communication Between US Physicians and Patients Regarding Electronic Cigarette Use. JAMA Netw Open, 2022. 5(4): p. e226692. DOI:10.1001/jamanetworkopen.2022.6692

[11] Otsuka Y., et al., Awareness, Attitudes, and Concerns Regarding Heated Tobacco Products Among Physicians in Japan. J Epidemiol, 2023. 33(9): p. 441-449. DOI:10.2188/jea.JE20210470

[12] Otsuka, Y., et al., Prevalence, knowledge, and concerns regarding the use of heated tobacco products and electronic cigarettes among young Japanese physicians. Tob Induc Dis, 2024. 22. DOI:10.18332/tid/178508

[13] Department of Health and Social Care, Press release: Smokers urged to swap cigarettes for vapes in world first scheme’. GOV.UK, 2023. (Accessed: 01 May 2026)

[14] Buss, V.H., et al., Associations between the national ‘Swap to Stop’ programme offering free vapes for smoking cessation and quit attempts in England: Results from a population-based survey. Addiction, 2026. 121 (6): 1557-1565. DOI: 10.1111/add.70332

[15] Action on Smoking and Health (ASH), Use of e-cigarettes (vapes) among adults in Great Britain. 2021.

[16] Martelle, S., et al., U.S. healthcare provider risk perceptions of tobacco and nicotine-containing products. Intern Emerg Med, 2026. 21: 1325-1333. DOI: 10.1007/s11739-026-04321-1

[17] BAT, THR Perceptions Presentation, Unpublished, 1 June 2024 [18] BAT, THR Perceptions Presentation, Unpublished 2, 1 June 2024

[19] Human, D., et al., Saving Lives Like Sweden. Smoke Free Sweden 2023, 2023.

[20] World Medical Organization, Declaration of Helsinki (1964). Br Med J, 1996. 313(7070): p. 1448-1449. DOI: 10.1136/bmj.313.7070.1448a

[21] Sabashvili, M., et al., Role of tobacco in the development of oral leukoplakia and oral cancer. Dentistry, 2018. 8(6):495. DOI: 10.4172/2161-1122.1000495

[22] Noggle, B., et al., Oral cancer incidence among adult males with current or former use of cigarettes or smokeless tobacco: a population-based study. JMIR Cancer, 2024.10:e51936. DOI: 10.2196/51936

[23] Leite, F.R.M., et al., Effect of smoking on periodontitis: a systematic review and meta-regression. Am J Prev Med, 2018. 54(6):831–841. DOI: 10.1016/j.amepre.2018.02.014

[24] Karanjkar, R.R., et al., Effect of tobacco and nicotine in causing staining of dental hard tissues and dental materials: a systematic review and meta-analysis. Clin Exp Dent Res, 2023. 9(1):150–164. DOI: 10.1002/cre2.683

[25] Kauss, A.R., et.al., Influence of tobacco smoking on the development of halitosis. Toxicol Rep, 2022. 6;9:316-322. DOI: 10.1016/j.toxrep.2022.02.012

[26] Hajat, C., et al., The health impact of smokeless tobacco products: a systematic review. Harm Reduct J, 2021. 18: 1 21. DOI: 10.1186/s12954-021-00557-6

[27] Muthukrishnan, A., and Warnakulasuriya, S., Oral health consequences of smokeless tobacco use. Indian J Med Res, 2018. 148(1):35–40. DOI: 10.4103/ijmr.IJMR_1793_17

[28] Khan, Z., et al., Smokeless tobacco and oral cancer in South Asia: a systematic review with meta-analysis. J Cancer Epidemiol, 2014. 2014:394696. DOI: 10.1155/2014/394696

[29] Quadri, M.F.A., et al., Smokeless tobacco and periodontitis: a systematic review with meta-analysis. J Periodontal Res, 2024. 59(6):1062–1070. DOI: 10.1111/jre.13274

[30] Lee, P.N.,et al., Epidemiological evidence relating snus to health–an updated review based on recent publications. Harm Reduct J, 2013. 10(1), 36. DOI: 10.1186/1477-7517-10-36

[31] Araghi, M., et al., No association between moist oral snuff (snus) use and oral cancer: pooled analysis of prospective studies. Scand J Public Health, 2021. 49(8):833–840. DOI: 10.1177/1403494820919572

[32] Kopperud, S.E., et al., Oral lesions associated with daily use of snus, a moist smokeless tobacco product: a cross-sectional study among Norwegian adolescents. cta Odontol Scand, 2023. 81(6):473–478. DOI: 10.1080/00016357.2023.2178502

[33] Bankvall, M., and Jontell, M., Swedish smokeless tobacco and its impact on oral health: a systematic review. Acta Odontol Scand, 2026. 85:84–95. DOI: 10.2340/aos.v85.45421

[34] Dalrymple, A., et al., Enamel staining with e-cigarettes, tobacco heating products and modern oral nicotine products compared with cigarettes and snus: an in vitro study. Am J Dent, 2021. 34(1):3–9. PMID:

[35] La Rosa, G.R.M., et al., Nicotine pouches, oral cancer and tobacco harm reduction: current evidence and research priorities. Front Oral Health, 2026. 7:1761734. DOI: 10.3389/froh.2026.1761734

[36] Rungraungrayabkul, D., et al., What is the impact of nicotine pouches on oral health: a systematic review. BMC Oral Health, 2024. 24(1):889. DOI: 10.1186/s12903-024-04598-8

Chapter 6: THR: A Global Transformation

Smokeless Products: Market Access

[1] Bates, C., Regulation: Why less is more. E-cigarette summit, 2013. (Accessed: 6 July 2026)

A Case Study: United Kingdom vs Netherlands

[1] BMJ, Vaping overtakes smoking in Britain for the first time. 2025. (Accessed: 28 July 2026)

[2] Balogun, B., and Harker, R., The smokefree 2030 ambition for England. House of Commons Library, 2023. (Accessed: 27 July 2026)

[3] Trimbos Institute, Smoking in the Netherlands: Key statistics for 2024. 2024.

[4] Netherlands Food and Consumer Product Safety Authority (NVWA), Inspection results flavoured vapes ban, January–June 2024. 2024. (Accessed: 27 July 2026)

[5] National Institute for Public Health and the Environment (RIVM), Evaluation of the E-cigarette flavour ban (poster presentation). 2025.

[6] PDNW, Netherlands policy failure provides stark warning to EU: How a vape flavour ban backfired. 2026.

[7] Department of Health and Social Care, Press release: “Smokers urged to swap cigarettes for vapes in world first scheme”. Gov. UK, 2023. (Accessed: 26 July 2026)

[8] Action on Smoking and Health (ASH), Use of vapes (e-cigarettes) among adults in Great Britain. 2024.

[9] McNeill A., et al., E-cigarettes: an evidence update. Public Health England, 2015. (Accessed: 26 July 2026)

[10] Office of Health Improvement and Disparities (OHID), E-cigarettes and vaping: policy, regulation and guidance. Gov. UK, 2022. (Accessed: 25 July 2026)

[11] Royal College of Physicians, E-cigarettes and harm reduction: An evidence review. RCP, 2024. (Accessed: 25 July 2026)

[12] National Institute for Health and Care Excellence (NICE), Tobacco: preventing uptake, promoting quitting and treating dependence (NG209). 2021. (Accessed: 23 July 2026)

[13] Office of Health Improvement and Disparities (OHID), Nicotine vaping in England: 2022 evidence update main findings. Gov. UK, 2022. (Accessed: 23 July 2026)

[14] Action on Smoking and Health (ASH), Vaping: what you need to know. (Accessed: 25 July 2026)

[15] U.K. National Health Service (NHS), Vaping to quit smoking. (Accessed: 21 March 2025)

[16] U.K. National Health Service (NHS), NHS stop smoking services help you quit. (Accessed: 25 July 2026)

[17] Department of Health and Social Care, Press release: “Smokers urged to swap cigarettes for vapes in world first scheme”. Gov. UK, 2023. (Accessed: 23 July 2026)

[18] Office for National Statistics (ONS), Adult smoking habits in the UK: 2023. 2023. (Accessed: 23 July 2026)

[19] Office for Health Improvement and Disparities (OHID), The Khan review: making smoking obsolete. Gov. UK, 2022. (Accessed: 23 July 2026)

[20] Department of Health and Social Care, Press release: “Tobacco and Vapes Bill becomes law”. Gov. UK, 2026. (Accessed: 23 July 2026)

[21] National Institute for Public Health and the Environment (RIVM), Reducing the attractiveness of e-liquids to youth: a proposal for a restrictive list of tobacco-related flavouring ingredients. (Accessed: 25 July 2026)

A Case Study: Czechia

[1] European Commission, Attitudes of Europeans towards tobacco and related products: Czechia Factsheet, Eurobarometer SP539. 2024.

[2] Government of the Czech Republic, National Strategy to Prevent and Reduce the Harm Associated with Addictive Behaviour 2019-2027. 2019. (Accessed: 02 August 2026)

[3] European Commission, Attitudes of Europeans towards tobacco and electronic cigarettes: Czech Republic Factsheet, Special Eurobarometer 458. 2017. (Accessed: 02 August 2026)

[4] European Commission, Attitudes of Europeans towards tobacco and electronic cigarettes: Czech Republic Factsheet, Special Eurobarometer 458. 2024. (Accessed: 02 August 2026)

[5] Government of the Czech Republic, Addiction Policy Action Plan 2023-2025. 2023. (Accessed: 02 August 2026)

[6] Government of the Czech Republic, Programme Statement of Petr Fiala's Government. 2023. (Accessed: 02 August 2026)

[7] Czech Parliament, Decree No. 429/2025 Coll. amending Decree No. 37/2017 Coll., on electronic cigarettes, refill containers and herbal products intended for smoking. 2025. (Accessed: 02 August 2026)

[8] Friedman, A.S., and Xu, S., Associations of Flavored e-Cigarette Uptake With Subsequent Smoking Initiation and Cessation. JAMA Network Open, 2020. 3(6). DOI:10.1001/jamanetworkopen.2020.3826

[9] Farsalinos, K., et al., Patterns of flavored e-cigarette use among adult vapers in the USA: an online cross-sectional survey of 69,233 participants. Harm Reduc J, 2023. DOI: 10.1186/s12954-023-00876-w

[10] Senate Health Committee, Parliament of the Czech Republic, Resolution on the issue of the use of flavoured and sweet e-cigarettes among children (60th Resolution). 2024. (Accessed: 04 August 2026)

[11] Novinky, The Ministry has backed away from a blanket ban on vaping flavours. 2024. (Accessed: 04 August 2026)

[12] Blesk, Válek confirmed: There will be no blanket ban on e-cigarette flavors! But their packaging will change. 2024. (Accessed: 04 August 2026)

[13] New Zealand Ministry of Health, Restrictions on colours and flavours of vaping products. 2023. (Accessed: 04 August 2026)

[14] New Zealand Ministry of Health, Application process to become a specialist vape retailer. 2023. (Accessed: 04 August 2026)

[15] New Zealand Ministry of Health, New Zealand Health Survey Annual Data Explorer. 2025. (Accessed: 04 August 2026)

[16] New Zealand Ministry of Health, Regulatory Impact Statement: Visibility of vape products and proximity of Specialist Vape Retailers – reducing youth vaping. 2024.

[17] Health New Zealand | Te Whatu Ora, Vaping to quit initiative. (Accessed: 04 August 2026)

A Case Study: Sweden

[1] The Public Health Agency of Sweden, Tobacco and nicotine use (self-reported) by country of birth, sex and year. Percentage. (Accessed: 09 April 2026)

[2] Smoke Free Sweden, Power in a Pouch,

[3] Smoke Free Sweden, No Smoke Less Harm, 2024.

[4] World Health Organization (WHO), Tobacco-free generations: Protecting children from tobacco in the WHO European Region. 2017.

[5] Oral Nicotine Commission, Cigarettes to smiles. 2025.

[6] Swedish Parliament (Riksdag), Expenditure Area 9: Health Care, Medical Care and Social Welfare – Budget Bill for 2025.

[7] Smoke Free Sweden, New Milestone as Sweden enshrines policy that can turn the world smoke-free. 2025. (Accessed: 09 April 2026)

[8] Vejpkoiien.se, Parliament decided on a new target for tobacco and nicotine policy. 2024. (Accessed: 09 April 2026)

[9] Sveriges Riksdag, Excise duties on nicotine-containing consumer products after 2023. 2022. (Accessed: 10 April 2026)

[10] Swedish Parliament, Act (2022:1257O) on tobacco-free products. 2022. (Accessed: 10 April 2026)

[11] Public health Agency of Sweden, Tobacco free nicotine products. 2023. (Accessed: 09 April 2026)

[12] Tobaccoreporter, Sweden: Lawmakers reject vape flavour ban. 2022. (Accessed: 09 April 2026)

[13] Human, D., et al., The Swedish experience: a roadmap to a smoke free society. Smoke Free Sweden 2023. 2023.

A Case Study: Japan

[1] Euromonitor International, Market Sizes, Cigarettes – Japan, Tobacco: Euromonitor from trade sources/national statistics. (Accessed: 5 Feb 2026) [2] Euromonitor International, Market Sizes, Heated Tobacco – Japan, Tobacco: Euromonitor from trade sources/national statistics. (Accessed: 5 Feb 2026)

[3] Forey, B., et al., Japan in International Smoking Statistics: A collection of historical data from 30 economically developed countries (2nd ed), Oxford University Press, 2002. DOI:10.1093/acprof:oso/9780198508564.001.0001

[4] Otsuka, Y., et al., Comparison of the responses of cross-sectional web- and paper-based surveys on lifestyle behaviors of Japanese adolescents. Prev Med Rep, 2023. 36: p.102462. DOI:10.1016/j.pmedr.2023.102462

[5] Xu, S.S., et al., Reasons for Regularly Using Heated Tobacco Products among Adult Current and Former Adult smokers in Japan: Finding from 2018 ITC Japan Survey. Int J Environ Res Public Health, 2020. 17(21): 8030. DOI:10.3390/ijerph17218030

[6] World Economic Forum, 5 Japanese innovations that changed the world. 2016. (Accessed: 5 Feb 2026)

[7] Bloomberg, Japan: Where innovation is borderless. (Accessed: 5 Feb 2026)

A Case Study: New Zealand vs Australia

[1] Ministry of Health New Zealand, Annual Update of Key results 2024/25: New Zealand Health Survey. 2025. (Accessed: 7 Feb 2026)

[2] New Zealand Legislation, Smokefree Environments and Regulated Products Act 1990, Section 3A. 1990. (Accessed: 7 Feb 2026)

[3] Ministry of Health, New Zealand Health Survey highlights long term decline in smoking rates. 2025. (Accessed: 7 Feb 2026)

[4] New Zealand Government, Smokefree Amendment Bill Introduced. 2024. (Accessed: 7 Feb 2026)

[5] Ministry of Health, Trends in smoking and vaping: New Zealand Health Survey 2023/24. 2024. (Accessed: 7 Feb 2026)

[6] Action for Smokefree 2025 (ASH), Opinion: NZ is on the cusp of smokefree history, we should celebrate – Robert Beaglehole. 2025. (Accessed: 7 Feb 2026)

[7] Action for Smokefree 2025 (ASH), ASH responds to the latest smoking and vaping data. 2025. (Accessed: 7 Feb 2026)

[8] Ministry of Health, Smokefree 2025. (Accessed: 7 Feb 2026)

[9] Health New Zealand, Smoking and Vaping. (Accessed: 7 Feb 2026)

[10] Ministry of Health New Zealand, Recent changes to smokefree laws. 2025. (Accessed: 7 Feb 2026)

[11] Action for Smokefree 2025 (ASH), ASH Year 10 Snapshot Survey. 2025.

[12] Action for Smokefree 2025 (ASH), Youth vaping is falling, and smoking rates remain very low. 2025. (Accessed: 7 Feb 2026)

[13] RNZ, Daily smoking numbers plateau slight increase in vapers. 2025. (Accessed: 7 Feb 2026)

[14] RNZ, Health select committee erupts into heated debate over roll out of oral tobacco and nicotine products. 2025. (Accessed: 7 Feb 2026)

[15] Ministry of Health New Zealand, Vaping Facts, (Accessed: 7 Feb 2026)

[16] New Zealand Legislation, Smokefree Environments and Regulated Products Regulations 2021: Version as at 21 September 2023. 2023. (Accessed: 7 Feb 2026)

[17] New Zealand Customs Service, Reduction in duty on heated tobacco products on 1 July 2024. 2024. (Accessed: 7 Feb 2026)

[18] New Zealand Legislation, Smokefree Environments and Regulated Products Regulations 2021: Version as at 1 September 2025. (Accessed: 7 Feb 2026)

[19] NewsGP. Have GPs been supported for vaping to go prescription-only from October? 2021. (Accessed: 7 Feb 2026)

[20] The Mercury, Shock secret numbers expose Australia’s vape fail. (Accessed: 7 Feb 2026)

[21] Queensland Health, Everything you need to know about illicit tobacco and vapes. 2025. (Accessed: 7 Feb 2026)

[22] Levy, D.T., et al., The Australia Smoking and Vaping Model: The Potential Impact of Increasing Access to Nicotine Vaping Products.Nicotine Tob Res, 2023. 25(3): p. 486-497. DOI:10.1093/ntr/ntac210

[23] The Pharmacy Guild of Australia, Vape control smoked. 2024.

[24] A.L.I.V.E, Latest Firebombing news. 2025. (Accessed: 7 Feb 2026)

[25] Commins, P., Tobacco excise has passed a ‘tipping point’ and is fuelling black market, economists warn. The Guardian. 2025. (Accessed: 7 Feb 2026)

[26] Roy Morgan, Smoking increase among young Australians since “vaping sales ban” in 2024. 2025. (Accessed: 7 Feb 2026)

[27] Mendelsohn, C., Leading health experts urge lawmakers to reform vaping laws. 2023. (Accessed: 7 Feb 2026)

A Case Study: U.S.

[1] U.S. Centers for Disease Control and Prevention, National Centers for Health Statistics, National Health Interview Survey. (Accessed: 7 March 2026)

[2] Bao, W., et al., Electronic Cigarette Use Among Young, Middle-aged, and Older Adults in the United States in 2017 and 2018. JAMA Intern Med, 2020. 180(2): p. 313-314. DOI:10.1001/jamainternmed.2019.4957

[3] King, B. A., et al., Trends in awareness and use of electronic cigarettes among US adults, 2010-2013. Nicotine Tob Res, 2015. 17(2): p. 219-227. DOI:10.1093/ntr/ntu191

[4] U.S. Food and Drug Administration, The Relative Risks of Tobacco Products. (Accessed: 7 March 2026)

[5] National Academies of Sciences, Engineering, and Medicine, Public Health Consequences of E-Cigarettes. The National Academies Press, 2018. DOI:10.17226/24952

[6] U.S. Food and Drug Administration, FDA Permits Marketing of E-Cigarette Products, Marking First Authorization of Its Kind by the Agency. 2021. (Accessed: 7 March 2026)

[7] Based on U.S. Marlin Value Share of Total Vapor (Feb. 2022 – Apr. 2022).

[8] U.S. Food and Drug Administration, FDA Issues Marketing Decisions on Vuse Vibe and Vuse Ciro E-Cigarette Products. 2022. (Accessed: 7 March 2026)

[9] U.S. Food and Drug Administration, FDA Authorizes Marketing of Vuse Alto Tobacco-Flavored E-Cigarette Pods and Accompanying Power Unit. 2024. (Accessed: 7 March 2026)

A Case Study: Pakistan

[1] Global Action to End Smoking, State of Smoking and Health in Pakistan. (Accessed: 24 July 2024)

[2] Niaz, K., et al., Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer. Epidemiol Health, 2017. 39:e2017009. DOI:10.4178/epih.e2017009

[3] Ahmad, F., et al., Implementing smokeless tobacco control policy in Pakistan: a qualitative study among Naswar supply chain actors. Tob Control, 2021. 30(5): p. 548-552. DOI:10.1136/tobaccocontrol-2020-055748

[4] Hossain, M.M., et al., Malondialdehyde and heavy metal contents in Piper betel: Possible Risks of Heavy Metals in Human Health. J Food Compos Anal, 2024. 134:106540. DOI:10.1016/j.jfca.2024.106540

[5] Saeed, M., et al., Assessment of potential toxicity of a smokeless tobacco product (naswar) available on the Pakistani market. Tob Control, 2012. 21(4): p. 396-401. DOI: 10.1136/tc.2010.042630

[6] Saeed, M., et al., Biochemical composition of a smokeless tobacco product (NASWAR) used in Pakistan. J King Saud Univ. Sci, 2024. 36(5): 103168. DOI:10.1016/j.jksus.2024.103168

[7] Sankhla, B., et al., Genotoxic and carcinogenic effect of gutkha: a fast-growing smokeless tobacco. Addict Health, 2018. 10(1): p. 52-63. DOI:10.22122/ahj.v10i1.537

[8] Ahmad, F., et al., Smokeless tobacco control in Pakistan. J Postgrad Med Inst, 2020. 34(3): p. 139-141. (Accessed: 24 July 2024)

[9] Stanfill, S.B., et al., Global surveillance of oral tobacco products: total nicotine, unionised nicotine and tobacco-specific N-nitrosamines. Tob Control, 2011. 20(3):e2. DOI: 10.1136/tc.2010.037465

[10] World Health Organization and International Agency for Research on Cancer. Cancer Today - Dataviz. (Query: Age-Standardized Rate (World) per 100,000, Incidence, Both sexes, age [15-85+], In 2022 Lip, oral cavity). (Accessed: 13 August 2024)

[11] Rutqvist, L.E., et al., Swedish snus and the GothiaTek® standard. Harm Reduct J, 2011. 8:11. DOI:10.1186/1477-7517-8-11

[12] Swedish Food Agency's regulations (LIVSFS 2012:6) on snus and chewing tobacco.

[13] World Health Organization and International Agency for Research on Cancer, Global Cancer Observatory: Pakistan. 2022.

[14] The Tobacco Atlas, Country Factsheets - Sweden. (Accessed: 16 August 2024)

[15] The Tobacco Atlas, Country Factsheets - Pakistan. (Accessed: 16 August 2024)

[16] World Health Organization and International Agency for Research on Cancer, Cancer Today: Data visualization tools for exploring the global cancer burden in 2022. (Selection criteria: Age-Standardized Rate (World) per 100 000, Mortality, Both sexes, Cancer Type [Lip, oral cavity], Sweden, Pakistan), age [15-85+], (Accessed: 16 August 2024)

[17] World Health Organization and International Agency for Research on Cancer, Agents Classified by the IARC Monographs, Volumes 1–136. (Accessed: 30 July 2024)

[18] Azzopardi, D., et al., Chemical characterization of tobacco-free "modern" oral nicotine pouches and their position on the toxicant and risk continuums. Drug Chem Toxicol, 2022. 45(5): p. 2246-2254. DOI:10.1080/01480545.2021.1925691

[19] National University of Sciences & Technology (NUST), Illicit Cigarette Trade in Pakistan – Current Situation and Way Forward. 2024.

[20] Lahore University of Management Sciences (LUMS), Impact of Taxation on the Cigarette Sector in Pakistan – A Thorough Analysis. 2024.

[21] Human, D., et al., Saving Lives Like Sweden. Smoke Free Sweden 2023, 2023.

[22] Rodu, B., and Jansson, C., Smokeless tobacco and oral cancer: A review of the risks and determinants. Crit Rev Oral Biol Med, 2004. 15(5):252-63. DOI:10.1177/154411130401500502

A Case Study: Greece

[1] Statista, Health Indicators Greece report 2024.

[2] Eurobarometer, Attitudes of Europeans towards tobacco and related products. European Commission, 2024.

[3] TobaccoIntelligence, Greece: Heated tobacco market snapshot, November 2024.

[4] OECD, Tobacco Consumption, Measure: share of population who are daily smokers. (Accessed: 20 March 2026)

[5] Institute for Health Metrics and Evaluation (IHME), Health by location, Greece. (Accessed: 20 March 2026)

[6] Global Action to End Smoking, State of Smoking and Health in Greece. (Accessed: 20 March 2026)

[7] Smoke Free Greece. (Accessed: 20 March 2026)

[8] Greek Law 4715/2020 (Article 36),

[9] Greek Government, National Action Plan Against Smoking. 2019. (Accessed: 20 March 2026)

[10] Eurobarometer, Attitudes of Europeans towards tobacco and related products. European Commission, 2022.

Chapter 7: THR: Global Regulation

[1] Human, D., et al., Saving Lives Like Sweden. Smoke Free Sweden 2023, 2023.

[2] Snowdon, C., et al., Vaping Works. International Best Practises: United Kingdom, France, Canada and New Zealand. Property Rights Alliance, 2021.

[3] U.S. Food and Drug Administration (FDA), FDA launches program to more efficiently review nicotine pouch applications. 2025. (Accessed: 26 May 2026)

[4] U.S. Food and Drug Administration (FDA), Premarket Tobacco Product Applications. 2024. (Accessed: 26 May 2026)

[5] U.S. Food and Drug Administration (FDA), Searchable tobacco products database. (Accessed: 26 May 2026)

[6] U.S Food and Drug Administration (FDA), Public Law: Family smoking prevention and tobacco control and federal retirement reform. 2009.

[7] AP News, 5 takeaways from the AP’s report on Chinese disposable e-cigarettes flooding the US market. 2023. (Accessed: 24 May 2026)

[8] American Lung Association, E-cigarette or Vaping Use-Associated Lung Injury (EVALI). (Accessed: 24 May 2026)

[9] Triantafyllou, G.A., et al., Long-term outcomes of EVALI: a 1-year retrospective study. Lancet, 2021. 9(12), p.e112. DOI:10.1016/S2213-2600(21)00415-X

[10] AP News, Thousands of unauthorized vapes are pouring into the US despite the FDA crackdown on fruity flavors. 2023. (Accessed: 24 May 2026)

[11] Van Oordt, M., and Rosenberg, C.B., Taxing Harmful Habits. Finance and Development, IMF. 2026. (Accessed: 24 May 2026)

[12] World Customs Organisation, Harmonised commodity description and coding system (HS) 2022 edition. (Accessed: 24 May 2026)

[13] Smith, A., An inquiry into the nature and causes of the wealth of nations. London: W. Strahan and T. Cadell. 1776. Book V, Chapter II.

Chapter 8: THR: Scientific Engagement

[1] Office for Health Improvement & Disparities, Nicotine vaping in England: 2022 evidence update main findings. 2022. (Accessed: 24 May 2026)

[2] International Agency for Research on Cancer, World Health Organization, Are e-cigarettes less harmful than conventional cigarettes? (Accessed: 24 May 2026)

[3] Science and Technology Committee, E-cigarettes. Seventh Report of Session 2017-19. House of Commons, 2018.

[4] World Health Organization (WHO), Tobacco: E-cigarettes. 2024. (Accessed: 24 May 2026)

[5] Gottlieb, S., and Zeller, M., A nicotine-focused framework for public health. N Engl J Med, 2017. 377(12): p.1111-1114. DOI:10.1056/NEJMp1707409

[6] Balogun, B., and Harker, R., The smokefree 2030 ambition for England. House of Commons Library, 2023. (Accessed: 24 May 2026)

[7] Te Whatu Ora, What is vaping? Smoke free. (Accessed: 25 May 2026)

[8] Healthdirect, Vaping. 2024. (Accessed: 25 May 2026)

[9] Public Health England, Evidence review of e-cigarettes and heated tobacco products 2018: executive summary. 2018. (Accessed: 25 May 2026)

[10] Cummings, K.M., et al., The past is not the future in tobacco control. Preventive medicine, 2020. 140: p. 106183. DOI:10.1016/j.ypmed.2020.106183

[11] Münzel, T., et.al., Nicotine and the cardiovascular system: unmasking a global public health threat. Eur Heart J, 2025. 15: 1764-1781. DOI:10.1093/eurheartj/ehaf1010

[12] Miguel, R.T.D., and Steffensen, I., Unmasking flawed exposure attribution in nicotine and cardiovascular risk. European Heart Journal Open, 2026. DOI:10.1093/ehjopen/oeag059

[13] Münzel, T., et al., Nicotine as a cardiovascular drug: haemodynamic stress, oxidative injury, and the regulatory failure to protect the heart. European Heart Journal Open, 2026. DOI:10.1093/ehjopen/oeag065

[14] Euractiv, Interview: Varhelyi says health package is effort to keep pace with global competition. 2025. (Accessed: 01 August 2026)

[15] European Commission, Answer given by Mr Várhelyi on behalf of the European Commission to Question E-004350/2025: Are smoke-free alternatives better alternatives? Brussels: European Parliament. 2026. (Accessed: 01 August 2026)

[16] Baeyens, F., et al., False and misleading European Commission statements about novel nicotine product safety. Open letter to Ursula von der Leyen, 2026. (Accessed: 01 August 2026)

Chapter 10: Our Future Outlook

[1] Bates, C., Regulation: Why less is more. E-cigarette summit, 2013. (Accessed: 6 July 2026)

[2] World Health Organization (WHO), Tobacco-free generations: Protecting children from tobacco in the WHO European Region. 2017.

[3] European Commission, Europe's Beating Cancer Plan.

[4] Reitsma, M.B., et al., Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet, 2021. 397(10292): p. 2337-2360 DOI:10.1016/S0140-6736(21)01169-7

[5] Smoke Free Sweden, No Smoke Less Harm, 2024.

[6] Ramström, L., and Wikmans, T., Mortality attributable to tobacco among men in Sweden and other European countries: an analysis of data in a WHO report. Tob Induc Dis, 2014.12(1):14. DOI:10.1186/1617-9625-12-14

[7] World Health Organization and International Agency for Research on Cancer, IARC Monographs on the Identification of Carcinogenic Hazards to Humans. (Accessed: 6 July 2026)

[8] U.K. National Health Service (NHS), Vaping myths and facts. (Accessed: 20 May 2026)

[9] U.S. Food & Drug Administration. CTP Director Discusses Opportunities and Considerations for Addressing Misperceptions About the Relative Risks of Tobacco Products Among Adults Who Smoke. 2023. (Accessed: 20 May 2026)

[10] McNeill A., et al., E-cigarettes: an evidence update, Public Health England. 2015. (Accessed: 20 May 2026)

[11] Government of Canada, Vaping and quitting smoking. 2023. (Accessed: 20 May 2026)

[12] Travis N., et al., The Potential Impact of Oral Nicotine Pouches on Public Health: A Scoping Review, Nicotine Tob Res, 2024. p. ntae131. DOI:10.1093/ntr/ntae131

[13] Vaping Facts, Our position on vaping, Ministry of Health. (Accessed: 20 May 2026)

[14] O'Shea, O.K., et al., Acute beneficial effects of a functional energy shot on cognitive performance and mood states during cognitively demanding task performance: a randomized, double-blind, placebo-controlled, crossover trial. Front Nutr, 2025;11:1496092. DOI:10.3389/fnut.2024.1496092

[15] Cotter, J., et al., Examining the effect of L-theanine on sleep: a systematic review of dietary supplementation trials. Nutr Neurosci, 2026.29(2):224-238. DOI:10.1080/1028415X.2025.2556925

[16] European Commission. Special Eurobarometer 458: Attitudes of Europeans towards tobacco and electronic cigarettes. 2017.

[17] European Commission. Special Eurobarometer 458: Attitudes of Europeans towards tobacco and electronic cigarettes. 2024.

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